Treatment for Short Leg Syndrome in Child: Email Advice

Hello Dr. Blake,

My son has seen you several times for orthotics.  He was diagnosed with cerebral palsy, has bilaerally pronated feet, and mild scoliosis.

It's the scoliosis that I am trying to assess.  We have been to many doctors and chiropractors.  One doctor cited a shorter leg length as a reason for the scoliosis, but other professionals don't agree.  My son's spine when sitting is straighter than when he stands, so something in weight bearing changes his posture.  Also, if he tends to lean to one side in standing posture, I am wondering if that also affects the results seen in the x-rays.

I don't like to x-ray him often to reduce his exposure.  I want to get an accurate x-ray that eliminates other factors that might be impacting what is seen on the x-rays such as standing posture, pronated feet etc., in the hopes that I can see how much of it is his spine and how much comes from these other factors.  I hope that in this way, we can try to address these other factors individually and their impact on the spine, of course with the goal of correcting his scoliosis.

I hope that makes sense.

You are very good at evaluating gait and biomechanics and I was hoping you might provide some suggestions or referrals to professionals who you'd recommend that can help with what I'm trying to assess.

Sincerely,

Dr Blake's response: 

     Thank you for the email. I agree to be mindful of x ray exposure, but you also have to have accurate information to treat your son. Typically, once the orthotics are where I like them, I have the patient take an AP Standing Pelvic Xray with orthotics on but no lifts. I coach the patient to stand as straight as possible daring the xray to show a short leg. The xray gets the leg length difference, any pelvic rotations, any unevenness of the base of the spine, and also the lumbar part of the scoliosis. Since it is weight bearing, it has a true bearing on how he walks. After I review the xray, I will make recommendations on lifts, physical therapy, etc. I love sending patients who have pelvic or sacral base unevenness to Dr Irene Minkowsky here in San Francisco. She typically knows what profession can help the most. Hope this makes sense. Rich